NPI | 1306334289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0019681) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2025030498) |
Enumeration Date | 2018-04-26 |
Last Update Date | 2025-08-05 |